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Byline: By Madeleine Brindley Western Mail

The decision by Welsh Assembly Government officials to test-drive a robotic doctor on Welsh hospital wards, reveals just how far technology is being integrated into the NHS. Wales is at the forefront of a global telehealth revolution which has the potential to reshape the way we receive healthcare. Health Editor Madeleine Brindleyreports

BOTH the Welsh Assembly Government's 10-year plan for the future of the NHS in Wales, and the vision drawn up by health professionals, patient representatives and academics, envisages a health service which is among the best in the world.

Both talk about bringing health services closer to the patient, and moving more services back into the community.

At the heart of each of the two visions is a greater use of telehealth technologies.

But these technologies are neither the stuff of science fiction or wishful thinking, nor is the idea of using them to improve health services new, as hospitals and NHS organisations throughout Wales have been using telehealth in various forms for almost a decade.

Speaking at the seventh British Irish Council, on the Isle of Man, last month, First Minister Rhodri Morgan declared that Wales was at the forefront of the telehealth revolution.

He told delegates, 'Wales has a remarkable story to tell in this area. We have been at the forefront of telemedicine development in the UK for a number of years.'

Health Minister Dr Brian Gibbons added, 'Telemedicine is an important area of health care which is helping to enhance the patient experience by improving access to diagnosis and treatment.

'Patients in remote parts of Wales have benefited from the use of information and communication technology to provide healthcare from a distance and therefore keep patient services local.

'As we become more reliant on technology the potential for telemedicine to make further advances in the health service in Wales is huge.'

For the past 11 years, Welsh Assembly Government officials have been working to test telehealth technology and its applications in healthcare, testing patient acceptance of the new schemes and designing and implementing the infrastructure needed to deliver it.

Over that time investment in telehealth has grown considerably in Wales, from just a few hundred thousand pounds to millions - Dr Gibbons announced a commitment to spend an additional pounds 2.7m on telehealth over the next three years, earlier this year.

Telehealth - the term telemedicine has been replaced by the broader telehealth tag - literally means creating a presence of a health professional in a place where they physically cannot be. Most of the technology is based on the principle of video conferencing and the ability to send live and real-time images and other information to a remote site.

Richard Phillips, telehealth programme manager for the Welsh Assembly Government, said, 'We're doing an awful lot of work in the NHS and in health which is not medically-orientated.

'For example, the cancer networks are spread across the whole of Wales - to bring them together on a regular basis is a fairly major undertaking.

'Telehealth is a way of removing the geography and the distances so health care professionals can employ their time more efficiently and effectively, because they are not spending all their time travelling from point to point.'

While much telehealth work has concentrated on allowing experts, professionals and NHS managers to talk face-to-face over wide geographical distances without having to spend the best part of a day travelling, telehealth also holds exciting prospects and possibilities for patients.

For example, patients living in Mid Wales who have cancer are normally referred to Swansea for treatment, which involves a long and often arduous return journey to the centre.

But, with the appropriate telehealth technology, it is possible to bring the Swansea-based hospital specialist to a hospital, or even a GP surgery, within the patients' own community, without the specialist having to travel.

Such a system, which allows the specialist to remotely oversee the treatment, using video conferencing-style technology, benefits the patient, and their family, who no longer have to travel huge distances.

Since July 2000, Wales has embarked on a series of three 'demonstrator' projects to test the capabilities of telehealth systems:

The North Wales Minor Injuries and Teledermatology (NOW) project was designed to provide the network of community hospitals in North Wales with video conferencing facilities and linked support to acute hospitals for minor injuries in rural locations.

The project also included a programme of remote dermatology consultations via the same video conferencing techniques.

By March 31, 2003, 725 patients had been successfully referred in this way in the dermatology programme, with only a little more than four in 10 patients typically following the traditional route of treatment.

And an evaluation study of the programme revealed that patients agreed with this strand of telemedicine to cut down waiting times and travel and GPs broadly regarded it as effective in accessing dermatologists.

The Patient to Practitioner, Pembrokeshire to Powys P4 Telemedicine project was the second of the initial two demonstrator projects delivered by the telemedicine programme and was designed to develop, pilot and evaluate an appropriate telemedicine model for treating minor injuries in a rural area.

The project has been regarded as one component of the modernisation plans for the A&E and minor injuries service across the Dyfed and Powys area.

Proposals for the third demonstrator project were announced by former Health Minister Jane Hutt in 2002.

Its aims were to enable district general hospitals, such as Prince Charles Hospital's A&E department in Merthyr Tydfil, to treat children with burns, and to provide immediate virtual access to both the specialist expertise of the paediatric intensive care unit at the University Hospital of Wales, in Cardiff, plus the skills of the burns and plastic unit staff at Morriston Hospital, Swansea.

Mr Phillips said, 'Video conferencing facilities are now widely distributed across Wales and are used in three main areas - in clinical consultations with patients; in management to reduce travelling and in education, to train and supervise staff.

'The growth of nurse practitioners has been a means of ensuring as many services stay as local as possible, especially minor injuries services.

'Telehealth has allowed these nurses to get advice from a doctor linked to a specialist centre if anything out of the ordinary or untoward occurs.'

Perhaps one of the most exciting possibilities of telehealth is the ability to diagnose conditions - in one example telehealth was used to send an ultrasound of a pregnant woman in Swansea to a cardiologist in Cardiff who was able to diagnose, in real time, a hole in the heart of the unborn child.

But, despite its massive potential, the roll-out of telehealth systems in Wales has been slow and steady.

Mr Phillips said, 'The one thing that could cause a major problems and set the programme back years was if a patient mistake was made.

'We have to be ultra careful and everything has to be undertaken in a controlled, safe environment.

'That means the roll-out of the technology may not take place as quickly as I think it could or should - we have to temper our enthusiasm against the safety and security of the public at large.

'The pilots and projects we have conducted so far prove that the technology works, that it is robust and is applicable in a number of different areas.

'If we are to implement it, it could help the NHS to address a number of issues, such as access, equality and equity.

'We know that telehealth works in minor injuries and dermatology, we're now looking to use the limited funds we have in other areas, other specialties and other locations.'

But if telehealth is to play a greater role in the way health services are delivered, it will require a major shift in the culture of the way medicine is currently practiced.

Mr Phillips added, 'Telehealth has the ability to radically change the established mechanisms that we use.

'Why refer a dermatology patient to the local hospital department when you could contact the eminent specialist in the UK, Scandinavia or even Australia about your patient's condition from your own surgery?

'Certainly in just five years' time patients will have a totally different experience in terms of their involvement with healthcare and that will start at the door of the GP surgery.' Helping the patients in rural areas who are in need of dialysis: Dialysis is the means by which patients with end-stage kidney failure stay alive.

At present there are two options for patients - haemodialysis, which usually involves long hours spent hooked up to a machine in hospital up to three times a week, or continuous ambulatory peritoneal dialysis (CAPD), which patients can perform at home or at work, either four times a day or throughout the night.

But even though CAPD has given patients more freedom to continue with their normal daily lives, they still require close monitoring and expert support.

For dialysis patients living in rural Wales, that has typically meant healthcare professionals travelling large distances to monitor their charges at home.

North East Wales NHS Trust has been at the forefront of using telehealth systems to monitor patients at home.

Working with Baxter Healthcare it led a pilot study into the use of telehealth systems.

Patients are linked to the hospital by video-conferencing technology, and can use a standard television set to communicate with experts, for advice and for monitoring.

Dr Peter Rutherford, honorary consultant nephrologist at Wrexham Maelor Hospital, said, 'Telecare is very important in delivering care in patients' homes and improving care of their disease and symptoms.

'This can help maintain patients on a home-based therapy, rather than them gravitating towards more expensive hospital-based therapies.

'It's also easy to use and our nurses spend less time travelling to patients.'